Abstract
Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62 % female) accessing a university health center. Each semester, 9–13 % of students screened positive for depression, 2.5–3 % for suicidal ideation, and 33–38 % for alcohol misuse, while 10 % wanted help with smoking cessation and 12–13 % with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.
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References
Alschuler, K., Hoodin, F., & Byrd, M. (2008). The need for integrating behavioral care in a college health center. Health Psychology, 27, 388–393. doi:10.1037/0278-6133.27.3.388.
American College Health Association. (2010). Considerations for integration of counseling and health services on college and university campuses. Journal of American College Health, 58, 583–595. doi:10.1080/07448481.2010.482436.
American College Health Association (2012). American College Health Association-National College Health Assessment II: Undergraduate Students Reference Group Data Report Spring 2012. Hanover, MD: ACHA. http://www.acha-ncha.org/docs/ACHA-NCHA-II_UNDERGRAD_ReferenceGroup_DataReport_Spring2012.pdf.
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders identification test: Guidelines for use in primary care (2nd ed.). Geneva: World Health Organization.
Baldwin, J. A., Johnson, R. M., Gotz, N. K., Wayment, H. A., & Elwell, K. (2006). Perspectives of college students and their primary health care providers on substance abuse screening and intervention. Journal of American College Health, 55, 115–119. doi:10.3200/JACH.55.2.115-120.
Bastien, C. H., Valliéres, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.
Benton, S. A., Robertson, J. M., Tseng, W., Newton, F. B., & Benton, S. L. (2003). Changes in counseling center client problems across 13 years. Professional Psychology: Research and Practice, 34, 66–72. doi:10.1037/0735-7028.34.1.66.
Berg, C. J., Lust, K. A., Sanem, J. R., Kirch, M. A., Rudie, M., Ehlinger, E., … An, L. C. (2009). Smoker self-identification versus recent smoking among college students. American Journal of Preventive Medicine, 36, 333–336. doi:10.1016/j.amepre.2008.11.010.
Bowling, A. (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health, 27, 281. doi:10.1093/pubmed/fdi031.
Brown, R. L. (2011). Configuring health care for systematic behavioral screening and intervention. Population Health Management, 14, 299–305. doi:10.1089/pop.2010.0075.
Bryan, C. J., Corso, K. A., Rudd, M. D., & Cordero, L. (2008). Improving identification of suicidal patients in primary care through routine screening. Primary Care and Community Psychiatry, 13, 143–147.
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795.
Butler, K. M., Fallin, A., & Ridner, S. L. (2012). Evidence-based smoking cessation for college students. Nursing Clinics of North America, 47, 21–30. doi:10.1016/.j.cnur.2011.10.007.
Byrd, M. R., & Alschuler, K. N. (2009). Behavioral screening in adult primary care. In L. C. James & W. T. O’Donohue (Eds.), The primary care toolkit: Practical resources for the integrated behavioral care provider (pp. 121–130). New York: Springer.
Centers for Disease Control and Prevention. (2005). Behavioral risk factor surveillance system survey questionnaire. Atlanta, GA: U.S. Department of Health and Human Services.
Centers for Disease Control and Prevention (2012). Suicide facts at a glance. Retrieved from http://www.cdc.gov/ViolencePrevention/pdf/Suicide_DataSheet-a.pdf.
Cowan, P. F., & Morewitz, S. J. (1995). Encouraging discussion of psychosocial issues at student health visits. Journal of American College Health, 43, 197–200. doi:10.1080/07448481.1995.9940476.
Cronce, J. M., & Larimer, M. E. (2011). Individual-focused approaches to the prevention of college student drinking. Alcohol Research & Health, 34, 210–221.
Cuijpers, P., van Straten, A., van Oppen, P., & Andersson, G. (2008). Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. Journal of Clinical Psychiatry, 69, 1675–1685.
Cukrowicz, K. C., Schlegel, E. F., Smith, P. N., Jacobs, M. P., Van Orden, K. A., Paukert, A. L., … Joiner, T. E. (2011). Suicide ideation among college students evidencing subclinical depression. Journal of American College Health, 59, 575–581. doi:10.1080/07448481.2010.483710.
DeMartini, K. S., & Carey, K. B. (2012). Optimizing the use of the AUDIT for alcohol screening in college students. Psychological Assessment, 24, 954–963. doi:10.1037/a0028519.
Eisenberg, D., Golberstein, E., & Gollust, S. (2007a). Help-seeking and access to mental health care in a university student population. Medical Care, 45, 594–601. doi:10.1097/MLR.0b013e31803bb4c1.
Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007b). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77, 534–542. doi:10.1037/0002-9432.77.4.534.
Foote, J., Wilkens, C., & Vavagiakis, P. (2004). A national survey of alcohol screening and referral in college health centers. Journal of American College Health, 52, 149–157.
Funderburk, J. S., & Fielder, R. L. (2013). Primary mental health care model in a university health clinic: An advanced practicum experience. Training and Education in Professional Psychology, 7, 112–122. doi:10.1037/a0032022.
Funderburk, J. S., Fielder, R. L., DeMartini, K. S., & Flynn, C. A. (2012). Integrating behavioral health services into a university health center: Patient and provider satisfaction. Families, Systems, and Health, 30, 130–140. doi:10.1037/a0028378.
Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the academic productivity of university students. Journal of Mental Health Policy and Economics, 8, 145–151.
Kaplan, M. L., Asnis, G. M., Sanderson, W. C., Keswani, L., De Lecuona, J. M., & Joseph, S. (1994). Suicide assessment: Clinical interview vs. self-report. Journal of Clinical Psychology, 50, 294–298.
Kessler, R. (2009). Identifying and screening for psychological and comorbid medical and psychological disorders in medical settings. Journal of Clinical Psychology, 65, 253–267. doi:10.1002/jclp.20546.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627. doi:10.1001/archpsyc.62.6.617.
Klein, M. C., Ciotoli, C., & Chung, H. (2011). Primary care screening of depression and treatment engagement in a university health center: A retrospective analysis. Journal of American College Health, 59, 289–295. doi:10.1080/07448481.2010.503724.
Knight, J. R., Wechsler, H., Kuo, M., Seibring, M., Weitzman, E. R., & Schuckit, M. A. (2002). Alcohol abuse and dependence among U.S. college students. Journal of Studies on Alcohol, 63, 263–270.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x.
Lenk, K. M., Erickson, D. J., Winters, K. C., Nelson, T. F., & Toomey, T. L. (2012). Screening services for alcohol misuse and abuse at four-year colleges in the U.S. Journal of Substance Abuse Treatment, 43, 352–358. doi:10.1016/j.jsat.2012.01.001.
Lund, H. G., Reider, B. D., Whiting, A. B., & Prichard, J. R. (2010). Sleep patterns and predictors of disturbed sleep in a large population of college students. Journal of Adolescent Health, 46, 124–132. doi:10.1016/j.jadohealth.2009.06.016.
Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909–916. doi:10.1176/appi.ajp.159.6.909.
Mackenzie, S., Wiegel, J. R., Mundt, M., Brown, D., Saewyc, E., Heiligenstein, E., … Fleming, M. (2011). Depression and suicide ideation among students accessing campus health care. American Journal of Orthopsychiatry, 81, 101–107. doi:10.1111/j.1939-0025.2010.01077.x.
Moyer, V. A. (2013a). Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Pediatrics, 132, 560–565. doi:10.1542/peds.2013-2079.
Moyer, V. A. (2013b). Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 159, 210–218. doi:10.7326/0003-4819-159-3-201308060-00652.
O’Connor, E., Gaynes, B. N., Burda, B. U., Soh, C., & Whitlock, E. P. (2013). Screening for and treatment of suicide risk relevant to primary care: A systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 158, 741–754. doi:10.7326/0003-4819-158-10-201305210-00642.
Orzech, K. M., Salafsky, D. B., & Hamilton, L. A. (2011). The state of sleep among college students at a large public university. Journal of American College Health, 59, 612–619. doi:10.1080/07448481.2010.520051.
Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption, II. Addiction, 88, 1788–1791. doi:10.1111/j.1360-0443.1993.tb02093.x.
Seigers, D. K. L., & Carey, K. B. (2010). Screening and brief interventions for alcohol use in college health centers: A review. Journal of American College Health, 59, 151–158. doi:10.1080/07448481.2010.502199.
Smith, M. T., Perlis, M. L., Park, A., Smith, M. S., Pennington, J., Giles, D. E., et al. (2002). Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry, 159, 5–11. doi:10.1176/appi.ajp.159.1.5.
Sutfin, E. L., McNamara, R. S., Blocker, J. N., Ip, E. H., O’Brien, M. C., & Wolfson, M. (2012). Screening and brief intervention for tobacco use by student health providers on college campuses. Journal of American College Health, 60, 66–73. doi:10.1080/07448481.2011.572325.
Taylor, D. J., Bramoweth, A. D., Grieser, E. A., Tatum, J. I., & Roane, B. M. (2013). Epidemiology of insomnia in college students: Relationship with mental health, quality of life, and substance use difficulties. Behavior Therapy, 44, 339–348. doi:10.1016/j.beth.2012.12.001.
Uebelacker, L. A., German, N. M., Gaudiano, B. A., & Miller, I. W. (2011). Patient Health Questionnaire depression scale as a suicide screening instrument in depressed primary care patients: A cross-sectional study. The Primary Care Companion to CNS Disorders, 13, e1–e6. doi:10.4088/PCC.10m01027.
U.S. Preventive Services Task Force. (2009a). Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine, 150, 551–555. doi:10.7326/0003-4819-150-8-200904210-00009.
U.S. Preventive Services Task Force. (2009b). Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics, 123, 1223–1228. doi:10.1542/peds.2008-2381.
U.S. Preventive Services Task Force. (2009c). Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 151, 784–792. doi:10.7326/0003-4819-151-11-200912010-00006.
Winters, K. C., Toomey, T., Nelson, T. F., Erickson, D., Lenk, K., & Miazga, M. (2011). Screening for alcohol problems among 4-year colleges and universities. Journal of American College Health, 59, 350–357. doi:10.1080/07448481.2010.509380.
Zakletskaia, L., Wilson, E., & Fleming, M. F. (2010). Alcohol use in students seeking primary care treatment at university health services. Journal of American College Health, 59, 217–223. doi:10.1080/07448481.2010.502413.
Acknowledgments
The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Veterans Affairs or other departments of the U.S. government. This study was supported by an American College Health Association United Healthcare Student Recourse Initiatives in College Mental and Behavioral Health grant awarded to the second author. The authors thank Cheryl Flynn, MD, MS, MA; Ben Domingo, MS, RN; Spiro Tzetzis, MD, and the rest of the staff at Syracuse University Health Services for their help with this project as well as the integrated behavioral health care program.
Conflict of Interest
Robyn L. Shepardson and Jennifer S. Funderburk declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation of Syracuse University and with the Helsinki Declaration of 1975, as revised in 2000. This study was approved as Exempt by the Syracuse University Institutional Review Board, so informed consent was not required.
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Shepardson, R.L., Funderburk, J.S. Implementation of Universal Behavioral Health Screening in a University Health Setting. J Clin Psychol Med Settings 21, 253–266 (2014). https://doi.org/10.1007/s10880-014-9401-8
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DOI: https://doi.org/10.1007/s10880-014-9401-8